Graham was a UK GP before training in Psychiatry in Australia. He has been dedicated for more than 40 years to psychiatric practice in Child and Adolescent Psychiatry. Follow Graham's early development in over 40 posts below. Search for 'Making of a Child Psychiatrist'

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Tuesday, July 19, 2016

Making of a Child Psychiatrist: (42) A Break from Work… (1)

Jan was now fulltime and becoming a respected member of her
Department of Chemical Pathology. She had survived a number of (what I saw as)
tests, coming home and having a bath to get rid of the pressures and smells of
the day. She regaled me with stories of having to take samples of faeces and
spoon them into a blender with certain chemicals so that she could measure the
fat content. At least, I think that was the story. She seemed surprised that I
found it slightly disgusting and, in retrospect, I can see what she meant. Her
job also involved using a pipette to transfer fluids to test tubes. I wondered
whether there were long-term safety concerns from various reagents; but at the
time the job and salary were crucial.

She moved on to doing some training in a new system of analysing blood
chemistry - the auto-analyser, first developed in the United States in the mid
1950s to measure urea, glucose and calcium. The version at King’s was an early model
of the Sequential Multiple Analyser with Computer (or SMAC). Instead of
ordering each specific test for a patient, and having this completed by a
technician using specific individual techniques that took time and effort, the
future was a non-specific process of batch analysis. That is, it would do all
the biochemistry on a patient whether each of the tests had been ordered or
not. Ultimately it became possible for these clever machines to analyse over 20
tests on up to 150 samples an hour. Jan’s equipment was a little more primitive,
mechanically bigger than later versions, and needed technician input for
reagents and trouble-shooting from time to time to correct process errors. The
results were not yet at the stage of being computerised, so there were paper
printouts and inks, all of which needed care and attention. But it was a
wonder, and Jan was excited to become part of the team.

From the medical point of view there was also excitement, and I
was later to become part of this when I worked in a Renal Unit for a while. As
the number of possible tests grew, and the speed with which they could be done
improved, the time we all had to wait for results shortened, and monitoring of patient
progress became easier, and therefore safer.

I guess we were focused on our lives, and somewhat oblivious of
what was happening in the outside world. Was it important to us that India
gained a woman prime minister in Indira Ghandi, or that two US Gemini space
capsules were to dock in orbit, or that a Playboy Bunny Club opened up in
Earl’s Court, or that The Beatles did what was to be their last live
performance as a group? Not much, really. We were aware of some of these
things, but did not watch television, nor read papers. We did listen to the
radio from time to time, and we revelled in bits of music (The Beach Boys’
‘Good Vibrations’, Dusty Springfield’s ‘You don’t have to say you love me’,
Frank Sinatra’s ‘Strangers in the Night’ and The Rolling Stones’ ‘Paint it
Black’ and so on), but it was all a passing show. We were busy, and making our
own fun.

The summer holidays of 1966 loomed, and there was a sense that we
might never again have the joy of those long stretches of relaxation that you
get while at school and university. By this time I was studying hard and, being
selfish, I did not want to spend all my days studying while Jan was at work. I
argued we both deserved a break, and pressed her to negotiate hard to take
three weeks holiday. I understand it was not easy, and she may not have been
too popular, but she succeeded.

We planned a trip down to the South of France using our Vespa.
When I say ‘planned’, we checked our passports and worked out roughly how much
money we would need to take with us for food and some occasional accommodation.
But we took a rather flimsy, if quick and easy to erect, tent to use as often
as we could. I had the Vespa checked out by my contact on Coldharbour Lane. We
made sure the spare tyre was in good condition, and organised some Complan
(believe it or not) in case we could not find open shops. I bought a road map
of France, and GB stickers. We packed a case, which went on to the back rack of
the Vespa, and the other bits went on the front rack and, loaded up, skid lids
on we headed for Dover.

We had no plan except to head south. Jan had memories of driving
to Spain with her family and some other family friends in a two car convoy when
she was thirteen so, in a way we replicated that journey. Vaguely we thought we
might look up the Veyssières if we ever got close to Nonards in Corrèze. I had
been unable to contact my old penfriend Jacques, so it seemed unlikely. But
that was it. We were Mod gypsies in search of the sun, and had three whole
weeks to go somewhere.

From Calais, we went southeast to Amiens and then due south to
Paris, stopping in Beauvais. Our Vespa 150 petrol tank had a capacity just over
8 litres including about 2.5 litres in the reserve. This gave us a range of
about 200Kms, fully loaded with the two of us riding. Both of us were getting
used to riding on the right side of the road, but I was a bit nervous about
suddenly running out of petrol. So, initially we took things a bit easy,
keeping the speedo at about 60Kms/hour, although the way the bike was singing,
I knew it would go faster. The Vespa was supposed to have a top speed of over
80Kms, but we were loaded down and in no rush; we wanted ‘to enjoy the journey’
(to quote a cliché), enjoy each other’s company, and hear ourselves speak over
bike and traffic noise.

About lunchtime we would stop in a small town and seek out a
boulangerie or a small supermarché, buying baguettes, jambon, various types of
fromage, apples, water and wine. Simple fare, although we occasionally could
not resist a patisserie. Often we went to a small café, and had pain au
chocolat, or a small meal and coffee, buying supplies for later in the day. As
the day began to fade, we would find a camping ground, pull off the road, set
up the tent and crash until first light. Someone had advised us that the truck
stops had great French food at very cheap prices, and that proved to be excellent
advice. Anything with a ‘Relais Routiers’ sign on it turned out to be great. We
got laughed at sometimes for our transport, our clothes (maybe) and limited
French, but when we did get to interact, we were welcomed.

We bypassed Paris because both of us had had some experience of
being hosted there as teenagers, but partly to avoid the big city and city
traffic. We also stopped only briefly at Versailles, given we had also been on
formal tours much earlier. But we did stop in Orleans, driven by a curiosity
about Jeanne d’Arc and her place in French history. One advantage of touring on
a Vespa, is that you cannot buy loads of souvenirs, so we took occasional slide
photographs using my Topcon camera, with a view to getting them developed on
return to England. Again we were parsimonious, I guess, and of course you end
up with fragments of memories that cannot be jogged in the usual way by objects
or photos, because you don’t have them. But memories, even faded ones, are a
precious part of shared experience, re-evoked by conversation.

The following day we drove through Châtoroux on our way to
Limoges, famous for its lace. And then, we headed for Carcassonne. Part of our
route went through a place we would come to know quite well in the future when
we had a French au pair from Montauban. But we thought it was delightful even
on our short pass through. On a bend of the river Tarn, with exquisite bridges,
Montauban is the second oldest of the walled cities of Southern France, with a
rich mediaeval history going back to 1200AD. The central square (‘Place Nationale’, of course) has
one of the oldest arched arcades providing memorable shade for weary
travellers.

Not only were we weary at the end of most days, even
through we were trying to take life easy, but summer was full of sunny days,
and the temperature had begun to climb, as expected for summer in the south of
France. As we reached Carcassonne, both Jan and I had burned foreheads, I guess
in part from the wind as much as the sun, although at times we had taken our helmets
off on long straight and fairly empty roads in an effort to stay cool. We must
have looked a sight with our increasingly begrimed outer gear. Yet we were
treated with immense acceptance, and sometimes respect. We had been warned that
we were stupid to have GB signs on the Vespa; that French people loathed the
English; that we would be treated rudely. But that was never my experience of
France as an adolescent, and there was never to be a negative experience during
this journey. I guess people were curious, and somewhat bemused. Perhaps we
were beginning to smell French, given the food and wine we had consumed, and
the fact that I was taking advantage to smoke Gitanes rather than my rather
boring English cigarettes. By this stage, my accented French was almost back to
being fluent with every day conversations, and Jan’s conversational French (and
confidence) had improved in leaps and bounds. While neither of us could have
held much of a philosophical conversation, the fact that we spoke French seemed
to open doors.

Coming down into Carcassonne is a breath-taking
experience of orange roofs overseen by a spectacular Citadel; a walled city
within a second set of walls left over from successive waves marauders
including crusaders in the 13th century. We could well have stayed
there for the rest of our holiday but, sadly, that was not the plan. So we set
up tent at a park, and set out early in the morning to attack the Pyrénées,
keen to get into Spain and find a good beach. The road to Andorra la Vella climbs
to 1,023 metres,
so while we only had 165 Kilometres of driving via Limoux and Ax-les-Thermes,
the higher we got, the more the poor Vespa struggled. Eventually we pulled into
a garage to top up the engine sputtered and stopped. I explained we needed
‘deux temps essence’ (two stroke fuel), only to be told they had none, and they
had no oil to add to petrol; they just had oil. I asked about the next garage –
about 40Kms down the mountain into Spain. I asked how we could get there
without petrol; they gave me the Gallic shrug.

So Jan and I took our loo break, and organised some
coffee and early lunch and sat looking at each other despondently. Our first
major downer. More than half seriously, I suggested we free-wheeled down the
mountain, and Jan was far from keen. But the only other alternative would be to
organise some truck to take us down. Coffee fortified, but anxious we decided
to just get on with it, we pushed the bike to the down track, got on and took
the brake off.

It was silent. All we could hear was the noise from
the tyres on the road. There were scattered piles of snow either side of the
road, although the surface seemed fine and had grip. The brakes had to be used
from time to time to slow our progress, particularly around the numerous
hairpin bends; I was just praying the brakes did not burn out. But we began to
enjoy the almost creepy silence. There were some cars coming up the mountains,
but seemed to be few going down; I guess everyone was at lunch.

And then suddenly a bend was too sharp, and as we braked
and tried to lean further into the bend, the wheels came out from under us, and
we were both flat out on a mountain road watching the Vespa spin slowly towards
the edge. I think the case on the back dragging along the dirt must have slowed
its progress, but I was never to be more grateful that the bike was constructed
from metal and not plastic. It stopped short of total disaster, and seemed to
be fairly intact seen from a distance.

We sat in shock, looking at each other. We were both
sore, but nothing appeared to be broken, although Jan had a nasty graze on her
ankle showing through torn socks. Of course being the not very organised future
doctor, I had not thought to bring a medical kit, so my nursing was quite
primitive! After some minutes of checking ourselves before standing, wondering
what to do, a car appeared coming up the mountain. A middle-aged Belgian couple
stepped out, and with perfect English asked if we needed some help? We did.

Of course they had a medical kit, and carefully cleaned
Jan’s graze, and put antiseptic cream on it before binding up the ankle ‘just
in case’. The husband helped me to retrieve the Vespa, which seemed
surprisingly OK. There was damage to the left handlebar, a graze on the side
panel and there were marks down the edge the left side leg protector. Our case
had been scraped, but survived without being breached. I checked everything out
with the help of my temporary friend, and we judged it to be serviceable.

We were seriously lucky; Jan’s leg could have been
trapped under the falling bike. The bike and all of our belongings could have
actually gone over the edge and downwards. The man suggested I try the engine,
and I told him my story from the top of the mountain. He commented that bikes
are known for not wanting to work in a rarified atmosphere. So we turned the
key, the engine sprang to life, and I had to add a second layer of embarrassment
to my battered self-esteem. How naïve can you be?